The Patient Told Me “You cannot take care of me. You’re black and I don’t like black people.” How Do You Respond?

 From the 12/18/2020 newsletter

 

Perspective                       

 

 

The Patient Told Me “You cannot take care of me.  You’re black and I don’t like black people.” How Do You Respond?

 

 

Victor Redmon, MD

 

 

Dr. Redmon, a resident in the Med/Peds Program, shares what he has learned about speaking up when experiencing or witnessing moments of injustice …

 

 

My name is Victor Redmon.  I am a fourth-year internal medicine and pediatrics resident here at the Medical College of Wisconsin Affiliate Hospitals (MCWAH).  I have served on the MCWAH Diversity and Inclusion (D/I) Committee since my intern year.  Given the current political landscape and the ever-present pandemic, we felt it necessary to put out a narrative centered around “accountability,” both for yourself and your colleagues around you. 

 

The year of 2020 has been one for the ages. I have been more cognizant of reading articles addressing intolerance, injustice, and micro-aggressions this year, more so than in years past.  A student of mine recently asked me particularly good questions about accountability and when to speak up for yourself and others, when either your colleagues or patients make insensitive remarks.  I do not know if I gave him the best answer at the time, partly because I do not know if there is one right answer give.  

 

 

A patient care story

 

In medical school, I was taking care of a woman during my third-year internal medicine clerkship.  She was Caucasian and in her 60s.  We were treating her for a pneumonia, UTI and encephalopathy.  She was admitted overnight and the next morning I decided to follow her as one of my primary patients.  I walked in the room alone and introduced myself along with my role on the team.  She took one look at me and said, “You cannot take care of me.  You’re black and I don’t like black people.” I paused and then she went ahead to ramble on about other things that didn’t make much sense.  I asked permission to examine her and she stopped talking and let me perform my examination.  Once I was done, I thanked her and told her I would see her later in the day.  She said “Okay, but I don’t like black people.”  As we continued to treat her infections, she became more coherent and "with it.”  

 

The next day when I went to see her, she greeted me with a “Good morning,” 

 

I replied back, “Good morning. It looks like you are feeling better today.” 

 

She said, “Yes, I am. Who are you?”  

 

I realized that she did not remember our first encounter, so I re-introduced myself.  She thanked me and the team for our treatments.  The rest of the encounter with her was very pleasant and we discharged her home eventually.   

 

I keep thinking about how and why I handled this encounter the way I did.  I knew the patient was delirious from her active infections and hospitalization.  Does that give her a pass for what she said to me?  How much truth was in her words?  I never told anyone on my team about what she said to me.  Not my fellow third-year student colleague, not my intern, not my senior resident and not my attending.  Why did I choose not to?   

 

 

Another patient care story

 

During my second year of residency, I was senior resident of one the medical ward teams at the VA.  We had a patient who was notorious for his abuse of the health system, bigotry, and sexism.   He was homeless, and every time he was admitted to the hospital, it was a saga to get him discharged.  If you worked at the VA long enough, you knew this guy by name alone.  You were either on his good side or his bad side.  I had taken care of him several times in the past, starting when I was still a medical student.  The patient and I had a good doctor-patient relationship, and he was never disrespectful to me.  I wish I could say that for others.   

 

My third day on the team, my intern following this particular patient came back to the room laughing.  I chuckled and asked him what was so funny.  “Oh Mr. So-and-So being Mr. So-and-So,” he replied, “he’s not so bad if you’re on his good side.”  The patient had been medically ready for discharge for weeks and we had been working with social work and case management to find him a place to stay since he required home oxygen therapy.   After rounds, my attending went to speak with the patient alone to basically tell him that he will be discharged the following day, and he could not stay in the hospital any longer.  My intern, who was of East Asian descent, was now very nervous about how this will affect his relationship with the patient.  I told him that the patient would be more likely to be mad at the attending, but I offered to be there for him if he needed me.  My intern declined and said, “I’ll just see how it goes.”  

 

The next day, my intern came in laughing again: “Mr. So-and-So being Mr. So-and-So.”  I took it as a positive sign and moved on.   During rounds, my attending asked how Mr. So-and-So was doing today.  My intern said “He’s fine, nothing has changed medically.  But he hates you,” referring to my attending.   My intern then said, “He says he never wants to see ‘that brown, Jihad *********** again’.”  

 

This statement is wrong on so many levels.  My intern then laughed it off.  My attending, of Indian descent, was silent for a moment, but then said, “Well unfortunately, he doesn’t have a choice.”  I looked around and the rest of the team (the other intern and two medical students) was dead silent.  As a team we moved on and finished rounds.   The patient was discharged without much drama.  

 

Internally, I was an emotional wreck.  I felt anger, remorse, shock and regret all at once.  I didn’t know how to respond in that moment.  I was with people I had not grown comfortable with yet, so I froze and didn’t respond at all.  

 

The following day was switch day for both the interns and the attending, so I had a whole new team.   Approaching the patient about what he said would have not been a battle worth fighting.  However, I never approached anyone else on the team about what was said, how they felt and how we could have done things differently.  I missed an opportunity to point out intolerance and injustice and to take a stance on a perpetuated culture that needs to end.  I feel like I failed my team.  I feel like I failed as a leader.  

 

 

What I have realized

 

I could continue to write about countless stories that are similar and worse than which I discussed above.  

 

Whatever personal accounts or stories that my friends and colleagues have experienced, these types of encounters happen every single day.  Often, we are silent and decide not to say anything so we can keep the peace.  I no longer regret being timid in those moments. I felt I was doing what was necessary to “survive” and progress to where I want to be in life.  I imagine that others have taken similar stances for similar reasons.  

 

I do not think there one “right or wrong” way to handle these situations, but I do think it is a reflection on how little improvement we have made as a society in addressing these issues. 

 

I realize now that it is not about me or one person at a given time.  It’s about all of us as a society.  As a medical society, we have a significant impact on our communities, especially the marginalized communities.  It does not matter if you are a medical student, a physician, nurse practitioner, physician assistant, a nurse, a medical assistant, a physical therapist, or a speech therapist.  You have a voice.  You have a platform to use to speak out against injustice, intolerance, and micro-aggressions that we too often meet in our work environment.  

 

I am far from perfect and I do not pretend to be free of my own implicit biases.  I hope to further an inclusive culture.  I want to be called out if I am being insensitive or have a moment of intolerance -- because that’s how we grow as humans.  I hope that I can learn from my failures and successes.  At the same time, I hope others can learn from my experiences and their own experiences as well.  

 

 

A challenge to all of us

 

We can no longer stay silent about these issues.  There is a lot of work to be done, but small simple steps eventually lead to larger ones.  I intend to start speaking up for my colleagues; especially for my trainees and students, who are in a particularly vulnerable period in their life.  I hope I am not alone.  For MCWAH D/I, we hope that we are not alone. 

 

 

 

Victor Redmon, MD is a fourth-year resident in the MCW combined medicine and pediatrics (Med/Peds) residency program.